Citation Nr: 20035656 Decision Date: 05/21/20 Archive Date: 05/21/20 DOCKET NO. 18-38 523 DATE: May 21, 2020 REMANDED Entitlement to service connection for sleep apnea associated with migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 2012 to September 2016. This appeal comes before the Board of Veterans’ Appeals (Board) from an April 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Veteran testified at a video conference hearing in the Newark, New Jersey RO before the undersigned Veterans Law Judge sitting at the Central Office in Washington, D.C. A transcript of the hearing is available in the record. 1. Entitlement to service connection for sleep apnea associated with migraine headaches is remanded. The Veteran has argued entitlement to service connection for obstructive sleep apnea (OSA). Initially, the Veteran filed a claim for secondary consideration to his service-connected migraine headache condition. See February 2018 VA Form 21-526EZ, Fully Developed Claim (Compensation). However, the Veteran has subsequently clarified his argument, which is that he believes during active military service, an undiagnosed OSA condition caused or aggravated his headache condition. See May 2018 Notice of Disagreement; July 2018 VA Form 9; and January 2020 Hearing Transcript. A preliminary review of the evidence shows medical and lay evidence regarding the Veteran’s headache condition and his OSA condition, no medical opinion of record has yet answered the question of whether it is at least as likely as not (50 percent or greater probability) that the Veteran had an undiagnosed OSA condition during service, for which the Veteran’s service-connected headache condition was merely a symptom. As a part of the duty to assist claimants, VA must provide a medical examination or obtain a medical opinion when such an examination or opinion is necessary to make a decision on the claim. Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007); 38 U.S.C. § 5103A (d)(1). Thus, the Board finds further development is necessary to address this question. Additionally, a preliminary review of the evidence indicates that no medical opinion of record has yet answered the question of whether the Veteran’s service-connected headache condition at least as likely as not (50 percent or greater probability) aggravated his OSA condition. Thus, the Board finds further development is necessary to address this possibility as well. See Barr, 21 Vet. App. at 310-11; 38 U.S.C. § 5013A (d)(1). The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion to determine whether the Veteran had an undiagnosed obstructive sleep apnea (OSA) condition during active duty, for which the Veteran’s service-connected headache disability was a symptom. The examiner is asked to directly answer the following question: Is it at least as likely as not (50 percent or greater probability) that during active service, the Veteran had an un-diagnosed OSA condition, for which his service-connected headache disability was merely a symptom? In answering the above question, the examiner’s attention is invited to the following evidence: (a) The Veteran’s diagnosis of OSA in November 2017, approximately 14 months after his discharge from active duty; (b) A VA Examiner’s opinion in March 2018 which stated the Veteran’s headache condition was possibly caused by his OSA, and not the other way around (see March 2018 C&P Examination); (c) The Veteran’s repeated contentions that use of a CPAP machine to treat his OSA has reduced the severity and frequency of his headaches (see October 2017 VA Medical Treatment Records; July 2018 VA Form 9; and see January 2020 Hearing Transcript); (d) Lay statement by the Veteran’s active duty commander, stating the Veteran frequently suffered from severe headaches in the morning hours during military training exercises (see February 2020 Buddy / Lay Statement); (e) Lay statement by the Veteran’s spouse indicating the Veteran has snored loudly since 2014 while on active duty, and echoing the Veteran’s statement that his treatment for OSA has alleviated his headache symptoms (see February 2020 Buddy / Lay Statement). 2. Obtain an addendum opinion to determine whether the Veteran’s service-connected headache condition aggravated the Veteran’s OSA beyond its natural progression. The examiner is asked to directly answer the following question: Is it as least as likely as not (50 percent or greater probability) that the Veteran’s service-connected headache disability aggravated his OSA condition beyond its natural progression? In answering this question, the examiner’s attention is invited to the statement by the VA examiner from March 2018, indicating a “clear relationship” between the Veteran’s headaches and his OSA (see March 2018 C&P Examination). K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Hermsdorfer, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.